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APPLICATION - -SITE APPROVAL <br /> a Z SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: SA-_ <br /> (rFOP� <br /> 2 <br /> r <br /> Describe any items of historical or archaeological interest on-site(e.g. cemeteries or structures): <br /> NONE <br /> Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise,heavy equipment,etc. : <br /> NEXT TO 99 HIGHWAY <br /> Describe any on-site or off-site sources of light of glare(e.g. parkinglot lighting,or reflective materials used <br /> NONE <br /> Describe an on-site or off-site source of odor(e.g. agricultural wastes): <br /> NONE <br /> Describe any displacement of people that will be caused by the project e. . numbers of people, housing units): <br /> NONE <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf-, and that the foregoing application statements <br /> are true and correct. <br /> Print Name: JAMES R. BIRD Signature: Date: 10-10-05 <br /> Print Name: ALYCE M. BIRD Signature: f l r Date: 10-10-05 <br /> Print Name: Signature: Date: <br /> Print Name- Signature: Date: <br /> Print Name: Signature: Date: <br /> F 1DEVSVCWRanning Application FonnslSite Approval.(Revised 1-3-03) Page 5 of 9 <br />